THE UNIVERSITY OF THE PHILIPPINES-COLLEGE OF MEDICINE in collaboration with
2
THE UNIVERSITY OF THE PHILIPPINES-COLLEGE OF MEDICINE in collaboration with POSTGRADUATE INSTITUTE OF MEDICINE and THE UNIVERSITY OF THE PHILIPPINES MEDICAL ALUMNI FUND INC. Invites you to THE 21 ST GRAND SCIENTIFIC SYMPOSIUM ROAD TO WELLNESS: A FAMILY FUN RUN EVENT FEBRUARY 2, 2014 LIWASANG ULALIM, CCP COMPLEX, PASAY CITY TIME : 5:00 AM pants below 18 years old must have their form signed by parent ian b must be worn at all times during the race. on stations will be provided in the race route Aid will be available in designaied areas ed parking areas will be available near the event’s area. deposit service will be provided. and special prizes awaits for registered participants prizes will be given for the first group / family with the most of members running together in the same distance category. prizes will be given for the group / family with the most number rs running together in the same distance category it includes race bib and shirt. tion Site uate Institute of Medicine, UP college of Medicine, Manila person/s: 8227612 [email protected] 09084308638 [email protected] Distance Gun start amount 10K 5:15am P 500 (student P400) 5K 5:30am P 400 (student P300) 3K 5:45am P 300 (student P200) RACE BIB NUMBER ____________ Runner’s Information (Please fill up all fields) First name: Middle name: Last name: Age /Sex: Address: Cellphone #: Email address: Distance Category : 10K ( ) 5K ( ) 3K ( ) Are you running with a group / family in the same distance category ? Yes ( ) No ( ) (* a group will compose of more than 2 members) If yes, how many including yourself? Names of group / family members : (please fill out extra registration form for other group members) 1. 2. 3. 4. 5. Shirt size: Free size Emergency Contact person: Emergency contact person’s number: Relationship: RELEASE OF LIABILITY I am physically/mentally fit to participate in the 21 st Grand Scientific Symposium ROAD TO WELLNESS: A family Fun Run event and have the full knowledge of the risks involved. I give my permission for the free use of my name(s) and photos in any medium of this event. In consideration to being permitted to participate, I for myself, heirs, executor and administrations do hereby waive and release forever any and all rights, claims and damages, I may have against the event organizers, sponsors, volunteers, race officials, and all participants involved. Participant’s/Parent’s/Guardian’s Signature Date signed: ________
description
REGISTRATION FORM RACE BIB NUMBER ____________ Runner’s Information (Please fill up all fields) First name: Middle name: Last name: Age /Sex: Address: Cellphone #: Email address: Distance Category : 10K ( ) 5K ( ) 3K ( ) - PowerPoint PPT Presentation
Transcript of THE UNIVERSITY OF THE PHILIPPINES-COLLEGE OF MEDICINE in collaboration with
T
THE UNIVERSITY OF THE PHILIPPINES-COLLEGE OF MEDICINEin collaboration with
POSTGRADUATE INSTITUTE OF MEDICINEand
THE UNIVERSITY OF THE PHILIPPINES MEDICAL ALUMNI FUND INC.Invites you to
THE 21ST GRAND SCIENTIFIC SYMPOSIUMROAD TO WELLNESS: A FAMILY FUN RUN EVENT
FEBRUARY 2, 2014LIWASANG ULALIM, CCP COMPLEX, PASAY CITY
ASSEMBLY TIME : 5:00 AM
•Participants below 18 years old must have their form signed by parent or guardian*Race Bib must be worn at all times during the race.*hydration stations will be provided in the race route *Medical Aid will be available in designaied areas*Allocated parking areas will be available near the event’s area.*Baggage deposit service will be provided.*Raffles and special prizes awaits for registered participants *Special prizes will be given for the first group / family with the most number of members running together in the same distance category.*Special prizes will be given for the group / family with the most number of members running together in the same distance category* Race kit includes race bib and shirt.
Registration SitePostgraduate Institute of Medicine, UP college of Medicine, ManilaContact person/s:Flo 09178227612 [email protected] 09084308638 [email protected]
Distance Gun start amount
10K 5:15am P 500 (student P400)
5K 5:30am P 400 (student P300)
3K 5:45am P 300 (student P200)
REGISTRATION FORMRACE BIB NUMBER ____________
Runner’s Information (Please fill up all fields)First name:Middle name:Last name:Age /Sex:Address:Cellphone #:Email address:
Distance Category : 10K ( ) 5K ( ) 3K ( ) Are you running with a group / family in the same distance category ? Yes ( ) No ( )(* a group will compose of more than 2 members)If yes, how many including yourself?
Names of group / family members : (please fill out extra registration form for other group members)1.2.3.4.5.
Shirt size: Free sizeEmergency Contact person:Emergency contact person’s number:Relationship:
RELEASE OF LIABILITY
I am physically/mentally fit to participate in the 21st Grand Scientific Symposium ROAD TO WELLNESS: A family Fun Run
event and have the full knowledge of the risks involved. I give my permission for the free use of my name(s) and photos in
any medium of this event. In consideration to being permitted to participate, I for myself, heirs, executor and administrations do hereby waive and release forever any and all rights, claims
and damages, I may have against the event organizers, sponsors, volunteers, race officials, and all participants
involved.
Participant’s/Parent’s/Guardian’s SignatureDate signed: ________
T
REGISTRATION FORMRACE BIB NUMBER ____________
Runner’s Information (Please fill up all fields)First name:Middle name:Last name:Age /Sex:Address:Cellphone #:Email address:
Distance Category : 10K ( ) 5K ( ) 3K ( ) Shirt size: Free size
Emergency Contact person:Emergency contact person’s number:Relationship:
RELEASE OF LIABILITY
I am physically/mentally fit to participate in the 21st Grand Scientific Symposium ROAD TO WELLNESS: A family Fun Run
event and have the full knowledge of the risks involved. I give my permission for the free use of my name(s) and photos in
any medium of this event. In consideration to being permitted to participate, I for myself, heirs, executor and administrations do hereby waive and release forever any and all rights, claims
and damages, I may have against the event organizers, sponsors, volunteers, race officials, and all participants
involved.
Participant’s/Parent’s/Guardian’s SignatureDate signed: ________
REGISTRATION FORMRACE BIB NUMBER ____________
Runner’s Information (Please fill up all fields)First name:Middle name:Last name:Age /Sex:Address:Cellphone #:Email address:
Distance Category : 10K ( ) 5K ( ) 3K ( ) Shirt size: Free size
Emergency Contact person:Emergency contact person’s number:Relationship:
RELEASE OF LIABILITY
I am physically/mentally fit to participate in the 21st Grand Scientific Symposium ROAD TO WELLNESS: A family Fun Run
event and have the full knowledge of the risks involved. I give my permission for the free use of my name(s) and photos in
any medium of this event. In consideration to being permitted to participate, I for myself, heirs, executor and administrations do hereby waive and release forever any and all rights, claims
and damages, I may have against the event organizers, sponsors, volunteers, race officials, and all participants
involved.
Participant’s/Parent’s/Guardian’s SignatureDate signed: ________
